Maurer Steven M, Hepp Zehra S, McCallin Shawna, Waibel Felix W A, Romero Federico C, Zorman Yılmaz, Lipsky Benjamin A, Uçkay İlker
Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Internal Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
J Bone Jt Infect. 2022 Mar 25;7(2):61-70. doi: 10.5194/jbji-7-61-2022. eCollection 2022.
Diabetic foot infection is a frequent complication in long-standing diabetes mellitus. For antimicrobial therapy of this infection, both the optimal duration and the route of administration are often based more on expert opinion than on published evidence. We reviewed the scientific literature, specifically seeking prospective trials, and aimed at addressing two clinical issues: (1) shortening the currently recommended antibiotic duration and (2) using oral (rather than parenteral) therapy, especially after the patient has undergone debridement and revascularization. We also reviewed some older key articles that are critical to our understanding of the treatment of these infections, particularly with respect to diabetic foot osteomyelitis. Our conclusion is that the maximum duration of antibiotic therapy for osteomyelitis should be no more than to 4-6 weeks and might even be shorter in selected cases. In the future, in addition to conducting randomized trials and propagating national and international guidance, we should also explore innovative strategies, such as intraosseous antibiotic agents and bacteriophages.
糖尿病足感染是长期糖尿病患者常见的并发症。对于这种感染的抗菌治疗，最佳疗程和给药途径往往更多地基于专家意见而非已发表的证据。我们回顾了科学文献，特别寻找前瞻性试验，旨在解决两个临床问题：（1）缩短目前推荐的抗生素疗程；（2）采用口服（而非胃肠外）治疗，尤其是在患者接受清创和血管重建术后。我们还回顾了一些对我们理解这些感染的治疗至关重要的早期关键文章，特别是关于糖尿病足骨髓炎的文章。我们的结论是，骨髓炎的抗生素治疗最长疗程不应超过4至6周，在某些特定情况下甚至可能更短。未来，除了开展随机试验并推广国家和国际指南外，我们还应探索创新策略，如骨内抗生素制剂和噬菌体。
